Provider Demographics
NPI:1699006007
Name:CAPRICIOUS CORPORATION
Entity Type:Organization
Organization Name:CAPRICIOUS CORPORATION
Other - Org Name:KIND HORIZONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-324-9771
Mailing Address - Street 1:5750 COVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-9110
Mailing Address - Country:US
Mailing Address - Phone:651-324-9771
Mailing Address - Fax:952-470-0541
Practice Address - Street 1:5750 COVINGTON RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-9110
Practice Address - Country:US
Practice Address - Phone:651-324-9771
Practice Address - Fax:952-470-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN347630253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care